| NPI | 1245895317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3128) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL1430) |
| Enumeration Date | 2019-05-04 |
| Last Update Date | 2022-07-05 |